Tracking# 2013-00335 
FA/P 6/7/13, eff. 8/1/13 

I:/12121201.rtf 
(I:/12121201.doc) 

(2 CCR 503-1)

[Instructions: insert before line 1511894.] 
Revisions of Sections 16.120, 16.210, 16.420, and 16.480 were final adoption following publication at the 6/7/2013 State Board of Human Services rule-making session, with an effective date of 8/1/2013 (Rule-making#12-12-12-1). Statement of Basis Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Office of Enterprise Partnerships, Division of Boards and Commissions, State Board Administration.

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[Instructions: replace lines 2266863 through 2266864.] 
16.120  DEFINITIONS [Rev. eff. 8/1/13]
As used in these rules, unless the context requires otherwise: 

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[Instructions: replace lines 2223136 through 2223140.] 

[ed.: definition of “developmental disabilities services” has been deleted.] 
"Developmental Disability" means a disability that: 
A.  Is manifested before the person reaches twenty-two (22) years of age; 
B.  Constitutes a substantial disability to the affected individual, as demonstrated by the criteria below at C, 1 and/or C, 2; and, 
C.  Is attributable to mental retardation or related conditions which include cerebral palsy, epilepsy, autism or other neurological conditions when such conditions result in either impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation. 
1.  "Impairment of general intellectual functioning" means that the person has been determined to have a full scale intellectual quotient equivalent which is two or more standard deviations below the mean (70 or less assuming a scale with a mean of 100 and a standard deviation of 15). 
a.  A secondary score comparable to the General Abilities Index for a Wecshler Intelligence Scale that is two or more standard deviations below the mean may be used only if a full scale score cannot be appropriately derived. 
b.  Score shall be determined using a norm-referenced, standardized test of general intellectual functioning comparable to a comprehensively administered Wecshler Intelligence Scale or Stanford-Binet Intelligence Scales, as revised or current to the date of administration. The test shall be administered by a licensed psychologist or a school psychologist.
c.  When determining the intellectual quotient equivalent score, a maximum confidence level of ninety percent (90%) shall be applied to the full scale score to determine if the interval includes a score of 70 or less and shall be interpreted to the benefit of the applicant being determined to have a developmental disability. 
2.  "Adaptive behavior similar to that of a person with mental retardation" means that the person has an overall adaptive behavior composite or equivalent score that is two or more standard deviations below the mean. 
a.  Measurements shall be determined using a norm-referenced, standardized assessment of adaptive behaviors that is appropriate to the person’s living environment and comparable to a comprehensively administered Vineland Scale of Adaptive Behavior, as revised or current to the date of administration. The assessment shall be administered and determined by a professional qualified to administer the assessment used. 
b.  When determining the overall adaptive behavior score, a maximum confidence level of ninety percent (90%) shall be applied to the overall adaptive behavior score to determine if the interval includes a score of 70 or less and shall be interpreted to the benefit of the applicant being determined to have a developmental disability. 
D.  A person shall not be determined to have a developmental disability if it can be demonstrated such conditions are attributable to only a physical or sensory impairment or a mental illness.
“Division for Developmental Disabilities” means the unit within the Colorado Department of Human Services, responsible for the administration of state sponsored services and funding for developmental disabilities for the state of Colorado.

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[Instructions: replace line 2266928.] 
"Request for Developmental Disability Determination" means written formal documentation, either handwritten or a signed standardized form, which is submitted to a Community Centered Board requesting that a determination of developmental disability be completed. 

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[Instructions: replace lines 737473 through 737508.] 
16.200  ADMINISTRATIVE SERVICES
16.210  COMMUNITY CENTERED BOARDS (CCB) [Rev. eff. 8/1/13] 
A.  Annually, any private corporation, for profit or not for profit, seeking designation as a Community Centered Board shall submit an application for designation to the Department.
1.  Applications shall be submitted in a form and manner specified by the Department which shall be made available to applicants upon request.
2.  The Department shall notify all applicants by first class mail of its determination of designation or non-designation by May 15 of each year.
3.  The designation shall cover a twelve (12) month period beginning July 1 and ending June 30.
4.  Designation of a Community Centered Board shall be based on the following factors: 
a.  Utilization of existing service agencies, social networks or natural sources of support in the designated service area. This shall be determined and based on an actual count of service agencies within a designated service area and a description of utilization of such agencies as well as a description of existing social networks and natural sources of support which were utilized.
b.  Encouragement of competition among service agencies within the designated service area to provide newly identified services or supports, the variety of service agencies available to the person receiving services within the designated service area, and the demonstrated effort to purchase new or expanded services or supports from service agencies other than those affiliated with the Community Centered Board. This shall be evaluated based on the ability of the applicant to substantiate such activities.
c.  Utilization of state funded services and supports administered at the local level, including, but not limited to, public education, social services, public health, and rehabilitation programs. This shall be determined based on a description of local utilization of state funded services and on a review of the previous fiscal year audit, current budget submission and the designated service area plan.
d.  Quality of services and supports provided for persons with developmental disabilities. Quality shall be measured based on compliance with federal and state licensing or program approval requirements, accreditation reports, agencies' self-evaluation efforts, and Department's quality assurance monitoring activities. Other resources to evaluate quality that may be considered include: analysis of disputes and complaints, use of grievance procedures, and measures of satisfaction by persons receiving services or supports.
e.  The establishment of new services and supports for the prevention of institutionalization, the support of deinstitutionalization, and a commitment to innovative, effective, and inclusive services and supports for persons with developmental disabilities. This shall be determined based on past performance, documented use of innovative and inclusive service and support approaches, effectiveness measures, and a description of the Community Centered Board’s future plans.
f.  The demonstrated effort of the applicant to pursue authorized services and supports for all eligible persons within the designated service area. This shall be determined based on both past performance and the applicant's written plan for addressing needed but unavailable services and supports.
5.  Any applicant that has not previously functioned as a Community Centered Board shall respond to the application process with statements of intent and plans in any area where past performance cannot be documented.
B.  If the Department determines that the Community Centered Board is in substantial compliance, the Community Centered Board shall receive designation. Upon designation, a Community Centered Board shall agree by contract to meet all requirements of Section 27-10.5, C.R.S., all rules and the following requirements: 
1.  In order to assure public accountability, the Community Centered Board shall be under the control and direction of a board of directors or trustees, pursuant to Section 27-10.5-105(2)(a), C.R.S.
2.  The board of directors or trustees shall adopt specific bylaw provisions which ensure that they are in compliance with all provisions of Section 27-10.5-105(2)(b), C.R.S., and: 
a.  Notice of meetings of the board of directors shall be posted in an identified public place at the Community Centered Board offices, and shall be made available at no cost to service agencies and anyone who requests the notice.
b.  Written minutes of all board meetings shall be maintained for three years as a matter of agency record and shall be available to the public on request at a reasonable cost not to exceed the costs allowed in Section 24-72-205, C.R.S.
c.  All meetings of a quorum of the board at which any public business is discussed or at which any formal action may be taken shall be open to the public for input. This does not apply to those matters covered in executive session pursuant to Section 27-10.5-105(2)(b), C.R.S.
d.  This section does not apply to any chance meeting or social gathering of the board at which discussion of the public business of the board is not the central purpose.
3.  Upon designation the Community Centered Board shall within available appropriations provide or arrange for services and supports which meet all the provisions of Section 27-10.5-105(2)(c) through (i), C.R.S., and:
a.  In accordance with reporting requirements of the Department's data system, maintain and update records of persons determined to be eligible for services and supports and who are receiving case management services. 
b.  Provide for case management services pursuant to Section 16.400 of these rules.
c.  Notify the eligible person and, if appropriate, their parents or guardian regarding the availability of services and supports pursuant to requirements of Sections 16.400 and 16.322.
d.  Establish a Human Rights Committee(s) as required in Section 16.550 of these rules.
e.  Devise and implement a plan for monitoring the programmatic practices of the Community Centered Board and contracted service agencies, pursuant to Section 16.460 in these rules.
C.  Each Community Centered Board shall submit annually a written long-range plan or an annual update to that plan for its designated service area pursuant to guidelines developed by the Department.
1.  The long-range plan or annual updates to the plan shall be developed through collaborative community efforts, facilitated by the community centered board, and shall include an annual public forum.
At a minimum, the designated service area planning process shall include appropriate opportunities and times for participation and input for persons with developmental disabilities who are receiving or waiting for services and supports: families who are receiving or waiting for services and supports; and service agencies under contract with the Community Centered Board.
2.  Copies of the written long-range plan or annual update must be available to the public during business hours at a reasonable cost not to exceed the costs allowed in Section 24-72-205, C.R.S.
D.  The Executive Director or designee shall review each Community Centered Board to assure that it complies with the requirements set forth in these rules.
E.  The Executive Director or designee may revoke the designation of a Community Centered Board upon a finding that the Community Centered Board is in violation of Section 27-10.5-101, C.R.S., et seq., as amended, other state or federal laws, or these rules.
Revocation of the designation of the Community Centered Board shall conform to the provisions and procedures specified in Section 24-4-104, C.R.S.
F.  Once a designation has been revoked, the Executive Director or designee may designate another private corporation, for profit or not-for-profit, to perform the case management services and administrative duties of the Community Centered Board pending designation of a new Community Centered Board.
G.  Any party may protest the decision of the Executive Director or designee to designate a Community Centered Board pursuant to provisions of Section 24-4-104(5), C.R.S.

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[Instructions: replace lines 737915 through 1101128.] 
16.420  DETERMINATION OF DEVELOPMENTAL DISABILITY [Rev. eff. 8/1/13] 
A.  Any person, his/her legal guardian, parent(s) of a minor or such person(s) authorized by law may submit a written request for a determination of whether the applicant has a developmental disability.
B.  A determination of developmental disability does not constitute a determination of eligibility for services or supports. The Community Centered Boards shall determine whether a person has a developmental disability and therefore may be eligible to receive services and supports pursuant to Sections 27-10.5-102 and 106, C.R.S., in accordance with criteria as specified by the Department.
Eligibility for Medicaid funded programs specific to persons with developmental disabilities shall be determined pursuant to the Colorado Department of Health Care Policy and Financing’s Medical Assistance rules (10 CCR 2505-10).
C.  The developmental disability determination shall be made according to Department procedures, which shall identify the qualifications of person(s) making such a determination.
D.  A request for determination of developmental disability shall be submitted to the Community Centered Board in the designated service area where the person resides, including temporary residence such as incarceration or hospitalization.
E.  At the time of request, the Community Centered Board shall: 
1.  Provide the applicant any required forms and a list of the minimum required documents and information necessary for the determination of developmental disability; and, 
2.  Provide the applicant with information on where to obtain testing for the level of intellectual functioning and adaptive behavior, if requested. The responsibility for obtaining such assessments shall be with the applicant and/or legal guardian. 
F.  The applicant and/or legal guardian shall provide all documentation and information necessary for the determination of developmental disability within ninety (90) calendar days of the request.
1.  The Community Centered Board may request additional documentation and/or information, as needed, to complete the determination of developmental disability.
2.  The applicant and/or legal guardian may have additional assessments completed and submitted to the Community Centered Board for consideration.
G.  If the applicant and/or legal guardian has not provided the documentation and information necessary for the determination within ninety (90) calendar days of the request, the Community Centered Board shall: 
1.  Close the request and notify the applicant in writing according to the procedures established at Section 16.420, L, 4; or, 
2.  The Community Centered Board may, at the request of the applicant and/or legal guardian, extend the deadline for providing the necessary documentation and information by up to an additional ninety (90) calendar days. 
a.  In no case shall the deadline for providing the necessary documentation and information exceed one hundred eighty (180) calendar days.
b.  The Community Centered Board shall provide a written update to the applicant no less than every ninety (90) calendar days until a determination of developmental disability is completed or the request is closed. 
c.  If the extended deadline for providing the necessary documentation and information has expired and there is still insufficient information to make a determination of developmental disability, the Community Centered Board shall close the request and notify the applicant and/or legal guardian in writing according to the procedures established at Section 16.420, L, 4. 
H.  For all applicants, the Community Centered Board shall enter into the Department’s designated data system and shall permanently maintain a written and/or electronic record of the developmental disability determination on a Department prescribed form. The record, at a minimum, shall include: 
1.  The name of the applicant;
2.  The applicant’s date of birth;
3.  The date of the determination of developmental disability;
4.  A description of the rationale for the developmental disability determination including, at minimum, assessment scores and diagnoses;
5.  The name(s) and title(s) of the person(s) involved in making the determination. 
I.  All information and assessments used to determine a developmental disability shall be current so as to accurately represent the applicant’s abilities at the time of determination.
1.  Assessments of adaptive behavior shall have been completed within three (3) years of the request.
2.  Assessments of intellectual functioning shall have been completed as follows: 
a.  If an individual is between five (5) and eighteen (18) years of age, at least one intellectual assessment shall have been completed to determine the individual’s impairment of general intellectual functioning; or, 
b. If an individual is eighteen (18) years of age or older and there is only one intellectual assessment available to determine the individual’s impairment of general intellectual functioning, the assessment shall have been completed when the individual was at least eighteen (18) years of age and shall have been completed within ten (10) years of the request; or,
c.  If there is historical pattern of consistent scores, based on two (2) or more intellectual assessments, that demonstrates an impairment of general intellectual functioning, the assessments may be used regardless of the individual’s age at the time of determination. 
3.  An established neurological condition shall be documented as follows: 
a.  A diagnosed neurological condition shall be determined by a licensed medical professional practicing within the scope of his/her license; or, 
b. If a specific diagnosis is not possible, a written statement from a licensed medical professional, practicing within the scope of his/her license, or a licensed psychologist may be used as long as there is a documented effort to determine a diagnosis and the available assessment information reasonably supports a conclusion that a neurological impairment is present. 
4.  The effects of mental illness or physical or sensory impairment must be considered to determine the extent to which such impairments are the sole contributing factor to the impairment of general intellectual functioning or limitations to adaptive behavior. 
J.  Prior to July 1, 2015, the Community Centered Board shall make the determination of developmental disability within ninety (90) calendar days of the receipt of all necessary information. On or after July 1, 2015, the Community Centered Board shall make the determination of developmental disability within (30) calendar days of the receipt of all necessary information.
K.  The date of the developmental disability determination shall be the date that the Department prescribed form and all documentation and information necessary for the determination of developmental disability was received by the Community Centered Board. 
If a delay to the determination of developmental disability is due to the actions or inactions of the Community Centered Board, the original date of request shall be used. 
L.  The Community Centered Board making the developmental disability determination shall, in writing, notify the applicant or legal guardian, and the authorized person requesting the determination, if other than the applicant or legal guardian, and other such persons as designated by the applicant, of the decision. Such notification shall: 
1.  Be mailed to the person within seven (7) calendar days of the date of determination;
2.  Be provided in such alternative means of communication as to reasonably ensure that the information has been communicated in an understandable form; and, 
3.  For persons determined to have a developmental disability, contain an explanation of the process that will occur and notice that, at a minimum, an Individualized Plan shall be developed upon enrollment in to a developmental disability service;
4.  For persons determined not to have a developmental disability or persons whose request is closed without the determination of a developmental disability, state the reasons for the determination or closure, and provide a written Long Term Care Notice of Action form in accordance with the provisions of Section 8.057.40, et seq. of the Colorado Department of Health Care Policy and Financing’s medical assistance rules (10 CCR 2505-10) regarding the applicant’s right to appeal the decision to the Office of Administrative Courts.
M.  Applicants determined not to have a developmental disability may request a new determination of developmental disability at any time upon receipt of new or missing required information, and a new request date shall be established.
N.  A determination of developmental disability shall be accepted by other Community Centered Boards, service agencies and regional centers.
O.  A determination of developmental disability shall be permanent and shall not require renewal or review unless: 
1.  The interdisciplinary team determines that developmental disability services are no longer needed due to improvement in a person’s condition and recommends a redetermination; or, 
2.  Information from a new evaluation becomes available which demonstrates sufficient improvement in a person’s condition such that the determination should be reviewed. 

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[Instructions: replace lines 737989 through 727999.] 
16.480  MEDICAID PROGRAMS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES [Rev. eff. 8/1/13] 
A.  For persons with developmental disabilities who are enrolled in Title XIX Medicaid programs, case management services shall be provided as required herein, and through the Colorado Department of Health Care Policy and Financing rules for Medicaid services (10 CCR 2505-10), and the guidelines of the Department. 
B.  Regional Center Referral Process
1.  Persons eligible or receiving services or supports may be referred to a regional center for emergency short-term placement not to exceed ninety (90) days. Such referral shall be made as specified by the Department and, at a minimum, shall ensure that the community centered board has exhausted all reasonable alternatives in an effort to procure or provide emergency services and supports in the person's local community.
2.  Persons eligible for or receiving services or supports may be referred to a regional center for long-term placement as specified by the Department. Such procedures shall include, but not be limited to: 
a.  The Community Centered Board responsible for case management services has notified the appropriate regional center and has involved the regional center in the evaluation process; and,
b.  The designated service area Community Centered Board and the person's Interdisciplinary Team have reviewed and recommended the placement; and,
c.  All reasonable alternatives have been exhausted by the Community Centered Board in an effort to procure or provide services and supports for the person in their local community and such efforts have been documented; and,
d.  The person or legal guardian is a bona fide resident of Colorado.
C.  Nursing Facilities 
For persons referred for a Preadmission Screening and Annual Resident Review (PASARR), the completion of the PASARR in accordance with the guidelines of the Department, shall be the responsibility of the Community Centered Board in the area in which the person is physically residing, unless otherwise agreed upon by the Community Centered Boards affected.

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